Monthly Archives: December 2013

Africa:Major Progress in Fight Against Malaria

24 December 2013
Geneva/ Washington DC — Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the World Malaria Report 2013 published by the World Health Organization (WHO).

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the ten countries with the highest malaria burden, and among children aged less than five years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627 000 malaria deaths. An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under five and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

[Courtesy AllAfrica News]

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Draconian Law setback for Uganda’s HIV response

Kampala, 23 December 2013 (IRIN) –
The draconian Anti-Homosexuality Bill passed by Uganda’s parliament on 20 December would deliver a major blow to the response to HIV/AIDS if it was enacted by President Yoweri Museveni, activists have warned.
Those found guilty of homosexual acts can be jailed for up to 14 years under the new law, a sentence that increases to life in “aggravated” cases, such as those committed by an HIV positive person, or those involving minors, the disabled and serious offenders.

Civil society activists fear that high-risk groups such as men who have sex with men (MSM) and sex workers – whose HIV prevalence is 13.7 and 33 percent respectively – will see their already limited access to prevention and treatment further eroded.

Amnesty International called the law “a grave assault on human rights [which] makes a mockery of the Ugandan constitution.

“President Museveni should avoid the trap of scapegoating a vulnerable minority in the interests of short-term political gain,” said Daniel Bekele, Africa director at Human Rights Watch.

“He should recognize that this repugnant bill is of no benefit to Ugandans – that it only serves to jeopardize basic rights – and reject it.”

The United States government has also called for the bill not to be enacted.

Here is a selection of reactions from those working on the front-line of the response to HIV/AIDS:

Pepe Julian Onziema, programme director, Sexual Minorities Uganda (SMUG), a local rights group

“It’s with deep disappointment that I receive the news of the Anti-Homosexuality Bill passing in our Parliament.”

“If the bill is assented to, the Act would spell a major setback for Uganda’s gains against HIV/AIDS as it will compromise doctor-patient confidentiality, which will push affected LGBTI (lesbian, gay, bisexual, transgender and intersex) persons further underground for fear of prosecution.”

Asia Russell, Director of International Policy, Health GAP

“This harmful and blatantly unconstitutional bill will deal a devastating blow to evidence-based efforts to end the AIDS epidemic in Uganda – a country that is almost unique among aast and southern African countries in that it has rising rates of new HIV infections. Why? Because existing criminalization provisions have meant prevention and treatment services aren’t reaching populations like MSM, who have much higher HIV prevalence.”

“Under this new bill, providing those services would now be illegal – we will see new infections continue to rise as populations get excluded further and further from life-saving treatment, prevention, information and support.”

Milly Katana, veteran activist and board members of the Global Fund to Fight HIV, Tuberculosis and Malaria

“Totally disheartening! It is one of those moments where as a country we move one step forward in realizing civil liberties and public health common sense, [then] we take 10 steps back.”

“The little achievements of the Ministry of Health starting to think of making services available to people who are most at risk of contracting HIV are put in total jeopardy. I hope the president, who has announced himself as a champion for HIV prevention by encouraging Ugandans to test for HIV and knowing their status, will see the non-wisdom in this Act and not assent to it.”

Alice Kayongo, Regional Policy and Advocacy Manager, AIDS Healthcare Foundation – Uganda Cares

“The effects of this (bill) will be felt in almost all sectors but most especially in the health sector and particularly for HIV/AIDS where over 80 percent of the AIDS response is funded externally.”

“Even with amendments, the proposed law will have an impact on the quality of healthcare and health education to be provided to gay people living with HIV for the fact that treating someone or providing them with HIV related information will be seen as a promotion act, yielding to imprisonment. While there have been indications of forward movement in this country’s AIDS response, we are at risk of losing so much of what we have gained in the recent past.”

“Evidently, with such developments in the political and legal environments, Uganda is miles away from attaining [the UN-backed target of] zero new HIV infections, zero AIDS-related deaths and zero discrimination. It will not be a surprise if Uganda’s prevalence rate stagnates around 7.3 percent in 2017. However, we still have some hope, His Excellency President Yoweri Kaguta Museveni should reject the passing of this bill into law and everything else will fall into place.”

Flavia Kyomukama, director of the Global Coalition on Women and HIV/AIDS in Uganda

“At a time when the country is trying to implement the national HIV prevention strategy that has underscored the sex workers and MSM as key in the reduction of the epidemic, the legislature thinks it’s a waste of time to have these people access services.”

“A mother, a teacher, a health worker, an employer is by obligation expected to report any LGBT within 72 hours of notice and confirmation that someone is LGBT.”

“How do I report my son? As a teacher how do I report my student who comes to me in confidence? And as a health aide how do I abuse the confidence of the patient? All of us are going to be imprisoned.”
“If the proponents of the bill claim homosexuality is a mental disorder, is it logical to [give] life imprisonment? The [logical] approach would be counseling and treatment.”

And here are some reactions from champions of the new legislation:

Simon Lokodo, Uganda’s state minister for ethics and integrity

“This bill is going to cater for the lacuna which has been existing in the current law and legal frameworks in Uganda concerning this unnatural act. Having passed this bill, a lot has been done to protect our children and innocent victims who would be lured into these western cultures and behaviours, which are totally unacceptable to us.”

“The law is going to condemn any recruitment, promotion and financing of the activities related to these malpractices.”

“On the threats from donors and development to withdraw their financial assistance over this bill, we don’t care and are not bothered at all. We prefer to lose that money than our culture and people.”

“We have an obligation as a sovereign state to protect our people against this unnatural act.

Michael Lulume Bayiga, shadow health minister

“I am happy and excited this bill was passed. We are waiting for the president to assent to it in order for it to become a law. I am particularly happy with the provision that bans the promotion of this cult (homosexuality). This provision will ensure this act will doesn’t take root in our country.”

“No health worker asks patients whenever they seek treatment from a health facility about their sexual orientation, unless he/her chooses to do so. For all the years I practiced medicine, I have never known any sexual orientation of my patients. There is no discrimination in the health service provision.”

[Courtesy of IRIN]